Provider Demographics
NPI:1114603891
Name:CARNEAL, BRADLEY J
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:J
Last Name:CARNEAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 RINKUS DR
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-8461
Mailing Address - Country:US
Mailing Address - Phone:314-596-6721
Mailing Address - Fax:
Practice Address - Street 1:3100 OAKLAND AVE STE 1C
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-3277
Practice Address - Country:US
Practice Address - Phone:724-349-5671
Practice Address - Fax:724-349-6375
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician